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Natural history of congenital complete atrioventricular block
M Michaelsson1, T Riesenfeld, A Jonzon
1Department of Pediatrics, Uppsala University Children's Hospital, Sweden.
Insights
Congenital complete atrioventricular block poses risks of heart failure and sudden death from fetal life. Early pacemaker implantation is crucial for infants and adults with symptomatic or severe bradycardia.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Electrophysiology
Background:
- Congenital complete atrioventricular block (CCAVB) is a serious condition with potential for significant morbidity and mortality.
- Risk stratification and management strategies for CCAVB require ongoing updates based on natural history studies.
Purpose of the Study:
- To provide an updated review of the natural history of congenital complete atrioventricular block.
- To delineate prognostic indicators and update indications for pacemaker implantation across different age groups.
Main Methods:
- Review of existing literature and studies on the natural history of congenital complete atrioventricular block.
- Analysis of prognostic factors in utero and during infancy, childhood, and adulthood.
Main Results:
- Significant risks of heart failure, syncope, and sudden death are present at all ages, including fetal life.
- Unfavorable in utero prognostic signs include low/decreasing ventricular rate, hydrops, AV valve regurgitation, and low aortic flow velocity.
- Specific criteria for pacemaker implantation in infancy, childhood, and adulthood are detailed, emphasizing symptomatic bradycardia and specific ECG/echocardiographic findings.
Conclusions:
- Congenital complete atrioventricular block necessitates vigilant monitoring and timely intervention.
- Pacemaker implantation is recommended for all patients over 15 years old, and earlier for those with specific indications.
- Early recognition of prognostic factors and adherence to pacing guidelines can improve outcomes for affected individuals.
Abstract:
An update of studies on the natural history of congenital complete AV block is presented. A risk for heart failure, syncope, and sudden death is present at any age including fetal life. Unfavorable prognostic signs in utero are low and decreasing ventricular rate (VR), hydrops, AV valve regurgitation, and low aortic flow velocity. Indications for pacing in infancy are congestive heart failure, ventricular rate < 55 beats/min in isolated block and < 65 beats/min with associated disease, prolonged OTc, syncope attacks, frequent ventricular ectopic beats, and alternating ventricular pacemakers. Indications for immediate pacing in childhood and adult life are syncope, presyncope, VR rates lower than median for age, periods of junctional exit block, prolongation of QTc and mitral regurgitation, and change of ventricular pacemaker. Pacing is recommended to all patients older than 15 years.